| Emotionally unstable personality disorder Classification and external resources | |
| ICD-10 | (F60.3) |
|---|---|
| ICD-9 | 301.83 |
| MeSH | D001883 |
Borderline Personality Disorder (BPD) is a psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV Personality Disorders 301.83[1]) that describes a prolonged disturbance of personality function characterized by depth and variability of moods.[2]
The disorder typically involves unusual levels of instability in mood;
- "black and white" thinking, or "splitting";
- chaotic and unstable interpersonal relationships, self-image, identity, and behavior;
- as well as a disturbance in the individual's sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation.[3]
Onset of symptoms typically occurs during adolescence or young adulthood. Symptoms may persist for several years, but the majority of symptoms lessen in severity over time,[4] with some individuals fully recovering. The mainstay of treatment is various forms of psychotherapy, although medication and other approaches may also improve symptoms. While borderline personality disorder can manifest itself in children and teenagers, therapists are discouraged from diagnosing anyone before the age of 18, due to adolescence and a still-developing personality.
There are some instances when BPD can be evident and diagnosed before the age of 18. The DSM-IV states: “To diagnose a personality disorder in an individual under 18 years, the features must have been present for at least 1 year.” In other words, it is possible to diagnose borderline personality disorder in children and teens, but only if the symptoms have been present, continuously, for over a year.
There is some evidence that BPD diagnosed in adolescence is consistent in adulthood. It is possible that the diagnosis, if applicable, would be helpful in creating a more effective treatment plan for the child or teen.[5][6]
As with other mental disorders, the causes of BPD are complex and unknown.[7] One finding is a history of childhood trauma (possibly child sexual abuse),[8] although researchers have suggested diverse possible causes, such as a genetic predisposition, neurobiological factors, environmental factors, or brain abnormalities.[7] The prevalence of BPD in the United States has been calculated as 1 percent to 3 percent of the adult population,[7] with approximately 75 percent of those diagnosed being female.[9] It has been found to account for 20 percent of psychiatric hospitalizations. Common comorbid (co-occurring) conditions are mental disorders such as substance abuse, depression and other mood, and personality disorders. BPD is one of four diagnoses classified as "cluster B" ("dramatic-erratic") personality disorders typified by disturbances in impulse control and emotional dysregulation, the others being narcissistic,histrionic, and antisocial personality disorders.
The term borderline, although it was used in this context as early as the 17th century, was employed by Adolph Stern in 1938 to describe a condition as being on the borderline betweenneurosis and psychosis. Because the term no longer reflects current thinking, there is an ongoing debate concerning whether this disorder should be renamed.[7] There is related concern that the diagnosis stigmatizes people, usually women, and supports pejorative and discriminatory practices.[10]
People suffering from borderline personality disorder and their families often feel the hardships are compounded by a lack of clear diagnoses, effective treatments, and accurate information. At their request, the U.S. House of Representatives unanimously declared the month of May as Borderline Personality Disorder Awareness Month (H. Res. 1005, 4/1/08), citing BPD’s "prevalence, enormous public health costs, and ... devastating toll on individuals, families, and communities."
Contents[hide] |
History
Since the earliest record of medical history, the coexistence of intense, divergent moods within an individual has been recognized by such writers as Homer, Hippocrates and Aretaeus, the last describing the vacillating presence of impulsive anger, melancholia and mania within a single person. After medieval suppression of the concept, it was revived by Bonet in 1684, who, using the term folie maniaco-mélancolique, noted the erratic and unstable moods with periodic highs and lows that rarely followed a regular course. His observations were followed by those of other writers who noted the same pattern, including writers such as the American psychiatrist C. Hughes in 1884 and J.C. Rosse in 1890, who described "borderline insanity." Kraepelin, in 1921, identified an "excitable personality" that closely parallels the borderline features outlined in the current concept of borderline.[2]
Adolf Stern wrote the first significant psychoanalytic work to use the term "borderline" in 1938, referring to a group of patients with what was thought to be a mild form of schizophrenia, on the borderline between neurosis and psychosis. For the next decade the term was in popular and colloquial use, a loosely conceived designation mostly used by theorists of the psychoanalytic and biological schools of thought. Increasingly, theorists who focused on the operation of social forces were recognized as well. During the 1940s and 1950s a variety of other terms were also used for this group of patients, such as "ambulatory schizophrenia" (Zilboorg), "preschizophrenia" (Rapaport), "latent schizophrenia" (Federn), "pseudoneurotic schizophrenia" (Hoch and Polatin), "schizotypal disorder" (Rado), and "borderline state" (Knight).
The 1960s and 1970s saw a shift from thinking of the borderline syndrome as borderlineschizophrenia to thinking of it as a borderline affective disorder (mood disorder), on the fringes ofmanic depression, cyclothymia and dysthymia. In DSM-II, stressing the affective components, the diagnosis was known as the hooker disorder, Cyclothymic personality (Affective personality).[11]In parallel to this evolution of the term "borderline" to refer to a distinct category of disorder, psychoanalysts such as Otto Kernberg were using it to refer to a broad spectrum of issues, describing an intermediate level of personality organization[2] between neurotic and psychotic processes.[12]
Standardized criteria were developed[13] to distinguish BPD from affective disorders and other Axis I disorders, and BPD became a personality disorder diagnosis in 1980 with the publication ofDSM-III.[14] The diagnosis was formulated predominantly in terms of mood and behavior, distinguished from sub-syndromal schizophrenia which was termed "Schizotypal personality disorder."[12] The final terminology in use by the DSM today was decided by the DSM-IV Axis II Work Group of the American Psychiatric Association.[15]
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